Page 309 - SAHCS HIVMed Journal Vol 20 No 1 2019

Page 5 of 7 Original Research

analysis. This result disappeared after adjustment for sex and the participants reported cough in our study. Bringing up
age. Additional adjustment for CD4-cell count and viral load phlegm was reported by 30% of HIV-negative and 42% of
did not change the findings. PLHIV in studies conducted in HIC, 18,21,24 whereas this was
reported by only 2% of the participants in our study. Both
The occurrence of any respiratory complaint was associated coughing and bringing up phlegm were reported to happen
with age, female sex, BMI and a history of bronchial more in PLHIV than in HIV-negative participants. 18,21,24
hyper-reactivity (Table 4). When limiting the analysis Wheezing and whistling have only been evaluated in two
to breathlessness, age, female sex, BMI, bronchial studies from HIC. No difference was found between PLHIV
hyper-reactivity and a history of pulmonary infection were and HIV-negative participants. 24,25
the associating factors (Table 5).
In contrast, breathlessness was a frequently expressed
Discussion complaint with 22% of the participants in our study,
indicating that they experienced breathlessness. This is in
The frequency of respiratory complaints in our study was line with the literature, mostly from HIC, reporting that
surprisingly low when compared to what has been reported between 1.4% and 42% of the population experience
in the literature in studies from both HIC and LMIC. For breathlessness. People living with HIV were found to
coughing, a frequency of 17% – 40% has been reported in experience breathlessness more often than HIV-negative
18
17
HIC and 7% – 48% 19,20,21,22,23 in LMIC. In contrast, only 3.3% of individuals, 18,25,26 a finding that we could not confirm in
our study.
TABLE 3: Any respiratory symptom for all participants.
Model HIV- HIV-positive The following reasons should be considered to understand
negative
ART-naïve First-line ART Second-line ART the low number of respiratory complaints, except for
OR 95% CI OR 95% CI OR 95% CI breathlessness, noted among the participants in our study
Model 1: HIV REF 1.11 0.60–2.07 0.84 0.43–1.64 2.52 1.54–4.12* compared to previous studies. Firstly, our study population
Model 2: HIV + REF 1.01 0.53–1.93 0.70 0.35–1.40 1.55 0.91–2.64
age + sex differed from study populations in HIC. People living
Model 3: HIV + REF 1.19 0.59–2.40 0.80 0.39–1.68 1.32 0.70–2.48 with HIV from HIC represent a particular group with
age + sex + specific health risk behaviour, such as men having sex
other factors†
ART, antiretroviral therapy; OR, odds ratio; CI, confidence interval; REF, reference group. with men (MSM) or intravenous drug users with a higher
27
†, Other factors: body mass index, ever smoking, passive smoking, respiratory infections in percentage of smokers than the HIV-negative population.
the past (pneumonia and/or tuberculosis), bronchial hyper-reactivity. In our study cohort, PLHIV smoked significantly less than
*, p < 0.05, 1.
TABLE 4: Factors associated with any respiratory symptom.
Variable Univariable OR 95% CI p Multivariable OR 95% CI p
HIV-positive 1.65 1.05–2.60 0.03 1.13 (0.65–1.96) 0.65–1.96 0.66
Age (per 5 years increase) 1.26 1.13–1.39 < 0.01 1.20 (1.06–1.35) 1.06–1.35 < 0.01*
Female sex 3.49 2.20–5.54 < 0.01 2.40 (1.38–4.17) 1.38–4.17 < 0.01*
BMI 1.11 1.07–1.14 < 0.01 1.07 (1.04–1.11) 1.04–1.11 < 0.01*
Ever smoking 0.50 0.31–0.80 < 0.01 1.05 (0.60–1.83) 0.60–1.83 0.88
Passive smoking 0.95 0.59–1.52 0.82 - - -
Respiratory infection in the past† 1.76 1.16–2.66 < 0.01 1.36 (0.84–2.22) 0.84–2.22 0.22
Bronchial hyper-reactivity 3.70 1.92–7.13 < 0.01 2.25 (1.11–4.57) 1.11–4.57 0.03*
Environmental exposure‡ 1.52 0.66–3.50 0.32 - -
BMI, body mass index; CI, confidence interval; OR, odds ratio.
†, Defined as either a history of pneumonia or TB.
‡, defined as work in the mining industry or in a dusty job for > 1 year or any exposure to gas, chemical fumes or pesticides in work ≥ 1 year.
*, statistically significant at p < 0.05.
TABLE 5: Factors associated with breathlessness.
Variable Univariable OR 95% CI p Multivariable OR 95% CI p
HIV-positive 1.68 (1.03–2.76) 1.03–2.76) 0.04 1.01 (0.54–1.89) 0.54–1.89 0.98
Age (per 5 years increase) 1.34 (1.20–1.50) 1.20–1.50 < 0.01 1.34 (1.17–1.55) 1.17–1.55 < 0.01*
Female sex 5.17 (2.95–9.04) 2.95–9.04 < 0.01 3.59 (1.82–7.07) 1.82–7.07 < 0.01*
BMI 1.12 (1.09–1.16) 1.09–1.16 < 0.01 1.08 (1.04–1.12) 1.04–1.12 < 0.01*
Ever smoking 0.31 (0.18–0.56) 0.18–0.56 < 0.01 0.67 (0.34–1.32) 0.34–1.32 0.25
Passive smoking 0.84 (0.50–1.40) 0.50–1.40 0.50 - - -
Respiratory infection in the past† 2.13 (1.38–3.29) 1.38–3.29 < 0.01 1.76 (1.04–3.00) 1.04–3.00 0.04*
Bronchial hyper-reactivity 4.07 (2.10–7.89) 2.10–7.89 < 0.01 2.15 (1.02–4.51) 1.02–4.51 0.04*
Environmental exposure‡ 0.84 (0.31–2.27) 0.31–2.27 0.73 - - -
BMI, body mass index; CI, confidence interval; OR, odds ratio.
†, Defined as either a history of pneumonia or TB.
‡, defined as work in the mining industry or in a dusty job for > 1 year or any exposure to gas, chemical fumes or pesticides in work ≥ 1 year.
*, statistically significant at p < 0.05.

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